Increased Doses of Training Improve Nurses? CPR Skills

Each year, more than 200,000 adult cardiac arrests occur in U.S. hospitals and less than 26% of those patients survive, says the American Heart Association. Additionally, survival rates vary from hospital to hospital.

Could this be related to the way CPR education has traditionally been provided? To remain current in basic life support, healthcare providers only need to complete CPR training every two years. But studies show CPR skills can deteriorate within three to six months following this training, reports the AHA.

"If you took piano lessons, you wouldn't practice once and then do a concert a year later," says Gregory Norton, MHA, EMT-P, staff development senior coordinator at The Ohio State University Wexner Medical Center in Columbus, Ohio. "You'd practice every few weeks or every few months to keep your skills up."

Which why the AHA, in conjunction with Laerdal Medical, developed Resuscitation Quality Improvement, a self-directed, simulation-based performance and quality improvement program for healthcare professionals.

Besides improving CPR quality, the AHA has a goal to save 50,000 addition lives from preventable cardiac arrest death each year by 2025 through this new style of competency training.
OSU Wexner Medical Center has been involved in the RQI program for about four-and-half years, and Norton sits on the RQI stakeholders advisory board.

Here's how the quality improvement works.
1. High-Frequency Training

"RQI utilizes burst training, or [also referred] to as low-dose, high-frequency training," Norton explains. Healthcare professionals take part in hands-on CPR skills practice in 10 minutes every 90 days via a manikin connected to a computer system that provides real-time feedback on CPR metrics such as:

Compression rate

Depth

Compression release

Compression fraction

"You spend anywhere from about 5 to 15 minutes practicing your CPR skills and going through some cognitive content just to review the protocols and the dynamics of CPR and resuscitation in general," Norton says. "Instead of doing that annual or biannual education, where you're in class for a few hours, the short increments of training every three months mean you're constantly refreshing your skills."

The real-time feedback has also helped staff members make adjustments to improve their technique.

"We've got about 2,000 employees using the program now, and we have been successful at working with individuals that do struggle with the exercise, " he says. "We find ways to accommodate them whether it's getting a step stool or adjusting the height of the manikin. We've got one staff with arthritis, and she knows that she's got to put her wrist brace on when she's going to do her compression activity."

2. Easily accessible

Unlike traditional CPR training, RQI is available 24/7. At one hospital in the OSU WMC system, there are two carts that rotate through different units once a month, says Norton.

The rotation schedule is published so staff can either wait until the cart is on their unit that month or they can visit the cart on another unit. This allows sessions to be incorporated into staff members' typical work schedules.

"You're not having to leave the building and drive to our education center the way you would for a traditional class," Norton says.

At OSU WMC East Hospital in Columbus, the RQI cart was intentionally placed in an easily accessible common area.

"The one my department uses is right next to the gift shop and the bathroom. If my staff can get down to the gift shop every day, they can certainly get to the [RQI cart]," says Carol Gray, RN, assistant nurse manager at OSU WMC East Hospital.
3. Tracking and Compliance

Gray says it is not difficult to track metrics and compliance with training.

"I was able to set up a report that would show up on my desktop twice a week, and then I could run it through it and just see who's compliant and who's not," she says.

Unit managers must also communicate with the RQI administration, in this case, it would be Norton, to make them aware of staff members who are on leave, who have resigned, or who are just starting.
Norton says Gray's team is one of the highest performing in terms of compliance rates, consistently scoring 99% to 100%.

Gray says that enlisting the support of "self-identified champions" has contributed to the successful compliance rates.

"I provide them with the list of who's completed and who's hasn't, and [the champions] take it upon themselves to either encourage [the nurses] to get downstairs [to the RQI cart] on their own, or to actively take them downstairs," she says.

Friendly competition also helps with compliance.

"We have a company here in Columbus that makes very good cookies, and I said, 'If you get [the training] done in the first 30 days that the module comes out, I will buy the department—if everyone in the department's done—the cookies," she says.

Results

In addition to completion of the training, the system also tracks skills performance. The RQI system creates a score for each user based on chest compressions. A minimum passing score is 75%.

"We consistently are well above that," Norton says. "Over the last three to four years, our average score for all attempts was in the 80% to 88% range."Individual attempts are also consistently above average.

"When we look at our high scores, which is usually the final score that a person records, our high scores are consistently in the 88% to 92% band," he says. "Although, we routinely have individuals that are performing at an even higher level. A lot of our staff take it as a point of pride. They want to hit that high score. They want to see 95%, 98%, 100%."

This has translated to an increase in overall skills quality, Norton says.

"The more time you can spend on chest, the better outcomes are predicted to date, so we want to see a high compression fraction," he explains. "When we reviewed the compression fractions of the staff that's been on RQI, after one year of using the program, they went from 82% to 91%."

Norton points out that poor quality CPR is a preventable harm that can be addressed.

"Regardless of how long you've been in healthcare, if you're not training the appropriate way, and you're not getting positive feedback during that training, then there's probably room for improvement," he says. "Finding a more efficient way to train staff and to ensure that we're training them appropriately, should improve the overall resuscitation skills."

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